Provider Demographics
NPI:1285076018
Name:FREEMAN, EMILY DIANE (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DIANE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:DIANE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-495-2400
Mailing Address - Fax:502-495-6345
Practice Address - Street 1:9520 ORMSBY STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5017
Practice Address - Country:US
Practice Address - Phone:502-426-0606
Practice Address - Fax:502-426-0604
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008179363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100278060 (KOHMG)Medicaid
KY7100278060 (KOHMG)Medicaid
KYK105051 (KOHMG)Medicare PIN